A gorgeous lady that I’ve been working with came to me because what had started as light bladder leakage a few months ago, was turning into the first signs of pelvic organ prolapse.
Her youngest (of 2) had just turned 3, and she had kept up her fitness, running, doing pump classes and going to the gym.
Panicked at the experiences she was now having (bulging, heaviness, issues with the toilet) she came to me for a more therapeutic approach to exercise.
An initial assessment quickly showed us that she had some unhealed abdominal separation, and that her deep core loop wasn’t working as it should during exercise.
The thing was, in her eyes, given the age of her kids, she was a long way “post partum”, if you could even still use that term.
And so, given the time that had passed, she should be able to do anything - right?
Why were these issues showing up in our assessment together?
Like so many mums, she wasn’t ever given an exercise program that took her through all the right healing, and then progressed her into strength and fitness strategically and safely.
She had never had an assessment for diastasis recti, or function of her abdominal muscles. And so, her body had strength deficits and imbalances going on.
This meant that each time she went for her run, or did her pump class, thinking she was doing the right thing, it was placing more and more pressure on her pelvic organs, literally contributing to her symptoms.
According to the Continence Foundation of Australia, over half of all women who have had a child have had some level of prolapse.
And what I see in clinical practice, is that exercise is making it worse.
Here are the top 2 reasons -
1 - There's a rather shocking lack of education around post natal exercise.
Most women aren’t given good guidelines to follow or taught anything about their own physiology so they can make informed choices about fitness.
And so women come into our courses, like the beautiful mama I mentioned above, not realising that their exercise choices were not the right or best ones for them at that time.
There is a linear bridge that all women must progress along in post natal exercise. Going through A, B and all the way to Z, to be both healed and fit.
And there's not really any way around it.
When we don’t know, when we aren’t told what the steps are, we start exercising up near Z - even though our bodies are only able to currently tolerate A or B.
2 - Conditioning from living in a world that promotes ‘go hard or go home’ and ‘no pain, no gain’.
Truthfully, this conditioning encourages us to ignore our body’s signals. We are taught to feel the pain, feel the abdominal heaviness, experience the bladder leakage, and keep going anyway.
This has to change. It just leads to 2 steps forward, 2 steps back results.
It has to be ok for women to participate in a training routine that goes from healing to strengthening that takes time. There are steps to follow. And that if we follow the steps, we DO get there.
There’s a pressure and urgency that women feel to ‘already be there’ - training hard, and the question it leaves us with is - what’s wrong with slow and steady?
What’s wrong with taking a little longer to be able to run that 5km or lift that weight, if it means keeping our bodies in tact?
When I tell women to give running a rest for just a few weeks, because they are wetting themselves, initially they can panic.
There's an unhealthy pressure on women to perform in this way, and it needs to be ok to listen not to outside standards, but to our own body signals.
A lot of the panic can come from not knowing what to do instead. Not knowing that there are dozens of safe options out there to elevate heart rate, maintain fitness, and burn energy.
Exercise doesn’t have to feel painful and exhausting to be effective.
So what’s the solution if I have signs of pelvic organ prolapse?
Trusting our bodies, along with a bit of education on what should feel right and what should feel “wrong” can go a long way (a HUGE emphasis in our program).
While there are loads of exercises that are contraindicated (recommended to avoid), exercise can be therapeutic for pelvic organ prolapse.
Remember - If you have prolapse issues, your body is struggling with holding everything up and in.
Performing exercises that push everything out and down creates the opposite of any healing intentions.
If an exercise makes you leak, feel heaviness, or a bearing down sensation on your pelvic floor, stop immediately.
Common exercises that create the pushing out and down pressure that we want to avoid are things like V sits, planks, sit ups, ab bicycles and crunches.
Without the right information, experiencing pelvic organ prolapse can feel like a scary and hopeless condition. But there’s lots that can be done.
Start paying attention to your body, and take your time on your healing journey. Find a reputable source for exercise, and make sure that the program ensures you make progress each session, rather than doing damage.
The running and pump classes don’t have to be avoided forever, but like anything in life, there are no true shortcuts. The great news is, once it's healed properly, it usually stays that way.
Kristy Ahale is a Clinical Exercise Therapist. She has worked in the fields of corrective exercise and strength and conditioning for 18 years.
The Postpartum Method is a 3 level program that progresses women through the stages of healing and stability, followed by strength and fitness. It can be done online or in person in Melbourne. It's orthopaedically designed, and has been recommended by doctors Australia-wide.